Department of Neurology, Division of Palliative Care, University of Rochester Medical Center, Rochester, New York 14642, USA.
J Palliat Med. 2010 Apr;13(4):407-12. doi: 10.1089/jpm.2009.0278.
To determine the pattern and characteristics of palliative care (PC) consultations in patients with stroke and compare them with the characteristics of nonstroke consultations.
The palliative care program at Strong Memorial Hospital (SMH) was established in October 2001. SMH is a 765-bed academic medical center with approximately 38,000 discharges. For each consult from 2005 to 2007, we collected demographic, clinical, and service-related information. We explored similarities and differences in patients with different types of stroke, including patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hematoma. In addition, we compared these data to the nonstroke patients who had a palliative care consultation during the same time period.
Over the 3-year period from 2005 to 2007, there were a total of 101 consultations in patients with stroke (6.3% of all PC consultations). Of the 101 consultations, 31 were in patients with ischemic stroke, 26 in patients with intracerebral hemorrhage, 30 in patients with subarachnoid hemorrhage, and 14 in patients with subdural hematoma. Patients with stroke who had a PC consult were more functionally impaired, less likely to have capacity, more likely to die in the hospital, and to have fewer traditional symptom burdens than other common diagnoses seen on the PC consultation service. The most common trajectory to death was withdrawal of mechanical ventilation, but varied by type of stroke. Common treatments negotiated in these consultations included mechanical ventilation, artificial nutrition, tracheostomy, and less likely antibiobics, intravenous fluids, and various neurosurgical procedures.
Patients with stroke are a common diagnosis seen on an inpatient palliative care consult service. Each stroke type represents patients with potentially distinct palliative care needs.
确定脑卒中患者姑息治疗（PC）咨询的模式和特征，并将其与非脑卒中咨询的特征进行比较。
Strong Memorial 医院（SMH）的姑息治疗计划于 2001 年 10 月成立。SMH 是一家拥有 765 张床位的学术医疗中心，每年约有 38000 名患者出院。对于 2005 年至 2007 年期间的每一次咨询，我们收集了人口统计学、临床和服务相关信息。我们探讨了不同类型脑卒中患者之间的相似性和差异性，包括缺血性脑卒中、脑出血、蛛网膜下腔出血和硬膜下血肿患者。此外，我们将这些数据与同期接受姑息治疗咨询的非脑卒中患者进行了比较。
在 2005 年至 2007 年的 3 年期间，共有 101 例脑卒中患者接受了姑息治疗咨询（所有 PC 咨询的 6.3%）。在这 101 次咨询中，31 次是在缺血性脑卒中患者中进行的，26 次是在脑出血患者中进行的，30 次是在蛛网膜下腔出血患者中进行的，14 次是在硬膜下血肿患者中进行的。接受姑息治疗咨询的脑卒中患者的功能障碍更严重，更有可能丧失能力，更有可能在医院死亡，且传统症状负担比其他常见的姑息治疗咨询诊断要少。最常见的死亡轨迹是停止使用机械通气，但因脑卒中类型而异。在这些咨询中，常见的治疗方案包括机械通气、人工营养、气管切开术，以及较少使用抗生素、静脉输液和各种神经外科手术。
脑卒中患者是姑息治疗咨询服务中常见的诊断。每种脑卒中类型都代表着具有不同潜在姑息治疗需求的患者。
